D-PIP Workshop 2007 Education Session Screening Tools: Those used and others to consider I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity- Paul Lipkin

AAP D-PIP: Selected Screening Instruments Instrument Used for surveillance Used for screening* Ages and Stages Questionnaires (ASQ) 10 Parents’ Evaluation of Developmental Status (PEDS) 26 Denver II 13 Pre-screening Developmental Questionnaire (PDQ) 21 Bayley Infant Neurodevelopmental Screener (BINS) 1 Modified Checklist for Autism in Toddlers (M-CHAT) 2 Checklist for Autism in Toddlers (CHAT) 1

Developmental Screening Instruments General developmental screening Domain-specific developmental screening –Gross motor –Communication/Cognition Disorder-specific developmental screening –Autism and pervasive developmental disorders (Autism Spectrum Disorders) Parent Questionnaires Directly administered

Developmental Screening Instruments: General Ages and Stages Questionnaire Battelle Developmental Inventory (BDI) Screening Test Bayley Infant Neurodevelopmental Screener (BINS) Brigance Screens-II Infant Development Inventory Child Development Review Child Development Inventory (CDI) Denver-II Developmental Screening Test Parents' Evaluation of Developmental Status (PEDS)

Ages and Stages Questionnaire (ASQ) 4 months to 6 years 19 color-coded questionnaire for use at 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60 months 30 – 35 items per form describing skills Completed by parent report Taps most domains of development Takes about minutes, and 3 to score ASQ-Social-Emotional works similarly and measures behavior, temperament, etc. Can be photocopied

YES SOMETIMESNOT YET x x x x x x

Jordan B.

PARENTS’ EVALUATION OF DEVELOPMENTAL STATUS For children 0 to 8 years In English, Spanish, Vietnamese, Somali, Chinese Takes 2 minutes to score Elicits parents’ concerns Sorts children into high, moderate or low risk for developmental and behavioral problems 4 th – 5 th grade reading level Score/Interpretation form printed front and back and used longitudinally

X X X X 1 3 Jordan B. 1/9/2006

Referred to infants and toddlers Jordan B.

Autism & Pervasive Developmental Disorders: Perform at 18 (and 24*) month visit –Autism Behavior Checklist (ABC) –Checklist for Autism in Toddlers (CHAT) –Modified Checklist for Autism in Toddlers (M-CHAT) –Modified Checklist for Autism in Toddlers-23 (CHAT-23) –Pervasive Developmental Disorders Screening Test-II (PDDST-II) - Stage 1- Primary Care Screener –Pervasive Developmental Disorders Screening Test-II (PDDST-II) - Stage 2- Developmental Clinic Screener –Screening Tool for Autism in Two-Year-Olds (STAT) –Social Communication Questionnaire (SCQ) (formerly Autism Screening Questionnaire-ASQ) Developmental Screening Instruments: Disorder-specific

The M-CHAT (Modified Checklist for Autism in Toddlers) Free download at Takes 5 minutes to complete, 5 to score Autism screening recommended by Autism Expert Panel at 18 and 24 months Child is “at-risk” and needs further evaluation if: –Fails 2 critical items, or –Fails any 3 items Robins, D., Fein, D., Barton, M., & Green, J. (2001)

M-CHAT Sample Items  Does your child ever use his/her index finger to point, to ask for something?  Can your child play properly with small toys without just mouthing, fiddling, or dropping them?  Does your child take an interest in other children?

The M-CHAT Robins et al Questions: 6 “Critical” Items  Interest in Other Children: Does your child take an interest in other children?  Proto-declarative Pointing: Does your child ever use his/her index finger to point, to indicate interest in something?  Bringing object to show the parent: Does your child ever bring objects over to you (parent) to show you something?  Imitation: Does your child imitate you? (e.g., you make a face- will your child imitate it?)  Responding to name: Does your child respond to his/her name when you call?  Following a point: If you point at a toy across the room, does your child look at it?

1.Does your child enjoy being swung, bounced on your knee, etc.? YESNO 2.Does your child take an interest in other children? YESNO 3.Does you child like climbing on things, such as up stairs? YESNO 4.Does your child enjoy playing peek-a-boo / hide-and-seek? YESNO 5.Does your child ever pretend, for example, to talk on the phone, take care of dolls or pretend other things? YESNO 6.Does your child ever use his/her index finger to point, to ask for something? YESNO 7.Does your child ever use his/her index finger to point, indicate interest in something? YESNO 8.Can your child play properly with small toys (e.g.: cars or blocks) without just mouthing, fiddling, or dropping them? YESNO 9.Does your child ever bring objects over to you (parent), to SHOW you something? YESNO 10.Does your child ever look you in the eye for more than a second or two? YESNO 11.Does your child ever seem over sensitive to noise? (e.g. plugging ears)? YESNO 12.Does your child smile in response to your face or your smile? YESNO 13.Does your child imitate you? (e.g. you make a face-will your child imitate it?)? YESNO 14.Does your child respond to his/her name when you call? YESNO 15.If you point at a toy across the room, does your child look at it? YESNO 16.Does your child walk? YESNO 17.Does your child look at things you are looking at? YESNO 18.Does your child make unusual finger movements near his/hear face? YESNO 19.Does your child try to attract your attention to his/her own activity? YESNO 20.Have you ever wondered if your child is deaf? YESNO 21.Does your child understand what people say? YESNO 22.Does your child sometimes stare at nothing or wander with nor purpose? YESNO 23.Does your child look at your face to check your reaction when faced with something unfamiliar? YESNO M-CHAT (18-30 months)

Gross motor –Early Motor Pattern Profile (EMPP) –Motor Quotient (MQ) Communication/Cognition –Capute Scales (aka Cognitive Adaptive Test/Clinical Linguistic Auditory Milestone Scale-CAT/CLAMS) –Communication and Symbolic Behavior Scales- Developmental Profile (CSBS-DP): Infant Toddler Checklist –Early Language Milestone Scale (ELMS -2) Developmental Screening Instruments: Domain-specific

Directly Administered Tools Capute Scales (CAT/CLAMS) Brigance Screens-II Bayley Infant Neurodevelopmental Screener (BINS)

Capute Scales Cognitive Adaptive Test/ Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) Directly administered tool Blend of screening and evaluation instrument Measures visual-motor/problem solving (CAT) and expressive and receptive language (CLAMS) Age range 3-36 mo Results in developmental quotient and age equivalent 100 items minutes administration time English, Spanish, and Russian versions available Available from Brookes Publishing

Capute Scales

CLAMS Language *Should be performed by child E = Expressive; R = Receptive Seven Months: YesNo 1.Orients toward bell (1.0)R* X__ (upwardly/indirectly) Eight Months: 1.”Dada” inappropriately (0.5)EX__ 2.”Mama” inappropriately (0.5)EX__

Capute Scales CAT Visual Motor Problem Solving All of these must be performed by child Seven Months: Yes No 1. Attempts pellet (0.3)X__ 2. Pulls out peg (0.3)X 3. Inspects ring (0.3)X__ Eight Months: 1. Pulls ring by string (0.3)__X 2. Secures pellet (0.3)__X 3. Inspects bell (0.3)__X

CAT/CLAMS Scoring CLAMS Language Basal Age 5.0 Ceiling Age 8.0 Points beyond Ceiling Age 0.8 Language age equivalent 8.8 CLAMS DQ 8.8 / 9.0 = 0.97 x 100 = 97 (Age equivalent / Chronological age x 100) Full Scale DQ ( ) / 2 = 81 (CLAMS DQ + CAT DQ / 2) CAT Problem Solving Basal Age 5.0 Ceiling Age5.0 Points beyond ceiling age 1.0 Problem solving age equivalent6.0 CAT DQ 6.0 / 9.0 = 0.66 x 100 = 66 (Age equivalent / Chronological age x 100)

Brigance Screens Takes 10 – 15 minutes of professional time Produces a range of scores across developmental domains Relies primarily on observation and elicitation of skills (0-2 year age range can be administered by parent report) Detects children who are delayed as well as advanced 9 separate forms across 0 – 7 years of age Each produces 100 points and is compared to an overall cutoff Available in multiple languages Computer scoring software

Bayley Infant Neurodevelopmental Screener (BINS) Takes minutes Assesses neurological processes (reflexes, and tone); neurodevelopmental skills (movement, and symmetry) and developmental accomplishments (object permanence, imitation, and language) Uses directly elicited items per month age range Categorizes performance into low, moderate or high risk via cut scores. Provides subtest cut scores for each domain For use from months

BINS Risk Scores

New Developmental Screening Instruments* 2007 PEDS:DM (Parents' Evaluation of Developmental Status-- Developmental Milestones) –Expansion of PEDS – questions to be answered per visit –6-8 items per age/encounter; designed to replace informal milestones checklists –For children birth to 7-11 years – Parents’ Observations of Infants and Toddlers – POINT –For children 2 through 36 months –Takes just 15 to 20 minutes for the parent or caregiver to complete –Designed for early intervention professionals’ use – *Note: Unreviewed